Equity in training

Purpose and context

Tackling the issue of differential attainment is a vital part of this reform programme. Evidence shows that international medical graduates (IMGs), UK graduates from minority ethnic backgrounds and those with other minority protected characteristics experience worse outcomes than white UK graduates.

The 2021 report Bridging the Gap (BAPIO, 2021) states that differential attainment is “simply a manifestation of structural inequalities”, and that this manifests as “differential outcomes for doctors due to their age, race, gender, sexual orientation, ethnicity, disability, socio-economic deprivation or influenced by migrant status, rather than motivation, ability, effort or enterprise”.

These issues are so significant that HEE has already invested in understanding and addressing them, and our work on differential attainment is already active, building on learning from the Targeted GP Training Programme (Health Education England, 2020), (Health Education England, 2021).

We heard...

In addition to our GPST reform engagement, we have engaged directly with those that have lived experience of the factors that contribute to differential attainment, both nationally and regionally.

Through engaging with our IMG colleagues, we have heard of the challenges they face, including:

• the complexities and costs of immigration and visa systems;
• settling in a different culture;
• joining an overstretched healthcare system;
• adjusting to new workplace cultures and ways of working, including the service role of GP DiTs;
• issues of prejudice and discrimination;
• the personal impact of differential outcomes, including at recruitment, impacting on their allocated training location, subsequent training progression, examinations and assessments.

IMGs also spoke about the additional trauma of seeing differential care outcomes due to systemic inequalities and prejudice affecting patients, including them and their families.

The reality of racism, prejudice and discrimination is further proven by the recent report on Experiences of Racial Discrimination and Harassment in London Primary Care (HEE / NHSEI, 2022).

Priorities and action

We will continue to work to address issues of discrimination, prejudice, bias and specifically racism at individual, institutional and systemic levels, and to reduce differential attainment.

We have introduced the HEE programme for supporting overseas doctors in GPST. The programme has four key elements:

1. Selection/recruitment/placement

a. Earlier identification of trainees and targeted support

b. Allocation of placements and supervisors based on needs

2. Enhanced induction programme, including

a. New to UK practice induction

b. Supernumerary placements

c. Simulation training

d. Additional one-to-one support

e. e-Portfolio support

3. Educator development

a. Community of best practice

b. Cultural competence and safety training

c. Active bystander and allyship training

d. Feedback skills

4. Targeted interventions based on educational needs

a. Communication skills

b. Exam/Annual Review of Competency Progression (ARCP) support

c. Peer mentoring

d. Career advice

e. Personalised learning plans

We will also work with key stakeholders, educators and trainees to further understand the basis of inequity and to address this, including the recommendations of the BAPIO report as they apply to GPST.

We will also ensure that the delivery of the GP curriculum highlights inequalities in care delivery and ways to address them.